Usefulness of Apfel score to predict postoperative nausea and vomiting – single-center experiences
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Studenckie Koło Naukowe przy Katedrze Anestezjologii i Intensywnej Terapii, Wydział Lekarski w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
Katedra i Klinika Anestezjologii i Intensywnej Terapii, Wydział Lekarski w Katowicach, Śląski Uniwersytet Medyczny w Katowicach
Corresponding author
Łukasz Jerzy Krzych   

Katedra i Klinika Anestezjologii i Intensywnej Terapii, Śląski Uniwersytet Medyczny w Katowicach, ul. Medyków 14, 40-752 Katowice
Ann. Acad. Med. Siles. 2018;72:224-229
Postoperative nausea and vomiting (PONV) are uncomfortable for patients, can prolong hospitalization and can lead to more serious complications, including inadequate pain control or respiratory failure. Accurately predicting which patients are at risk of PONV can help physicians decide when to recommend prophylactic antiemetics. The aim of the study was verify whether the Apfel score is useful in predicting postoperative nausea and vomiting.

Material and methods:
A prospective observation was performed in a group of 101 patients (54F; median age 64y; 51 ASA3+) who underwent surgery between 01.2017 and 03.2017 in a high-volume university hospital. Demographic and clinical data was recorded and the Apfel score was calculated. For the final result, the occurrence of PONV on the first day after surgery was accepted.

The mean time of anesthesia was 216 ± 121 min. Most patients (n = 86) underwent gastro-intestinal surgery. Antiemetic prophylaxis was given to 68 persons. The median Apfel score was 2 (IQR 2–3). An Apfel score of 4 pts was found in 14 subjects. Postoperative nausea and vomiting occurred in 9 patients. Although none of the individual components of the Apfel scale predicted PONV in bivariate comparisons, the total score was useful in predicting PONV (AUC = 0.734; 95% CI 0.636–0.817; p < 0.01). Antiemetic treatment resulted in a 65% reduction in the occurrence of PONV (OR = 0.35; 95% CI 0.08–1.4; p = 0.1).

Although the Apfel score helps recognize patients at risk of PONV, identifying patients who should receive prophylactic antiemetics needs further investigation.

Shaikh S.I., Nagarekha D., Hegade G., Marutheesh M. Postoperative nausea and vomiting: A simple yet complex problem. Anesth. Essays Res. 2016; 10(3): 388–396, doi: 10.4103/0259-1162.179310.
Gan T.J., Diemunsch P., Habib A.S., Kovac A., Kranke P., Meyer T.A., Watcha M., Chung F., Angus S., Apfel C.C., Bergese S.D. i wsp. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth. Analg. 2014; 118(1): 85–113, doi: 10.1213/ANE.0000000000000002.
Hill R.P., Lubarsky D.A., Phillips-Bute B., Fortney J.T., Creed M.R., Glass P.S., Gan T.J. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology 2000; 92(4): 958–967.
Apfel C.C., Läärä E., Koivuranta M., Greim C.A., Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693–700.
Ustawa z dnia 5 grudnia 1996 r. o zawodzie lekarza; Rozdz. 4 (tekst jedn. Dz.U. 1997 nr 28 poz. 152). Dostęp:
Pechhold M., Walldén J. Is PONV still a problem? Eur. J. Anaesthesiol. 2013; 30(e-Suppl. 51): 8(1AP1-6).
Horn C.C., Wallisch W.J., Homanics G.E., Williams J.P. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur. J. Pharmacol. 2014; 722: 55–66, doi: 10.1016/j.ejphar.2013.10.037.
Apfel C.C., Heidrich F.M., Jukar-Rao S., Jalota L., Hornuss C., Whelan R.P., Zhang K., Cakmakkaya O.S. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br. J. Anaesth. 2012; 109(5): 742–753, doi: 10.1093/bja/aes276.
Sawatzky J.A., Rivet M., Ariano R.E., Hiebert B., Arora R.C. Post-operative nausea and vomiting in the cardiac surgery population: who is at risk? Heart Lung 2014; 43(6): 550–554, doi: 10.1016/j.hrtlng.2014.07.002.
Rodseth R.N., Gopalan P.D., Cassimjee H.M., Goga S. Reduced incidence of postoperative nausea and vomiting in black South Africans and its utility for a modified risk scoring system. Anesth. Analg. 2010; 110(6): 1591–1594, doi: 10.1213/ANE.0b013e3181da9005.
Pierre S., Benais H., Pouymayou J. Apfel’s simplified score may favourably predict the risk of postoperative nausea and vomiting. Can. J. Anaesth. 2002; 49(3): 237–242, doi: 10.1007/BF03020521.
Weilbach C., Rahe-meyer N., Raymondos K., Weissig A., Scheinichen D., Piepenbrock S. Postoperative nausea and vomiting (PONV): usefulness of the Apfel-score for identification of high risk patients for PONV. Acta Anaesthesiol. Belg. 2006; 57(4): 361–363.
Eberhart L.H., Högel J., Seeling W., Staack A.M., Geldner G., Georgieff M. Evaluation of three risk scores to predict postoperative nausea and vomiting. Acta Anaesthesiol. Scand. 2000; 44(4): 480–488.
Smith C.A., Ruth-Sahd L. Reducing the Incidence of Postoperative Nausea and Vomiting Begins With Risk Screening: An Evaluation of the Evidence. J. Perianesth. Nurs. 2016; 31(2): 158–171, doi: 10.1016/j.jopan.2015.03.011.
Kappen T.H., Moons K.G., van Wolfswinkel L., Kalkman C.J., Ver-gouwe Y., van Klei W.A. Impact of risk assessments on prophylactic antiemetic prescription and the incidence of postoperative nausea and vomiting: a cluster-randomized trial. Anesthesiology 2014; 120(2): 343–354, doi: 10.1097/ALN.0000000000000009.
Eger E.I. 2nd, Bowland T., Ionescu P., Laster M.J., Fang Z., Gong D., Sonner J., Weiskopf R.B. Recovery and kinetic characteristics of desflurane and sevoflurane in volunteers after 8-h exposure, including kinetics of degradation products. Anesthesiology 1997; 87(3): 517–526.
Matsuura H., Inoue S., Kawaguchi M. The risk of postoperative nausea and vomiting between surgical patients received propofol and sevoflurane anesthesia: A matched study. Acta Anaesthesiol. Taiwan 2016; 54(4): 114–120, doi: 10.1016/j.aat.2016.09.002.
Apfel C.C., Stoecklein K., Lipfert P. PONV: a problem of inhalational anaesthesia? Best Pract. Res. Clin. Anaesthesiol. 2005; 19(3): 485–500.
Bilgin T.E., Birbicer H., Ozer Z., Doruk N., Tok E., Oral U. A comparative study of the antiemetic efficacy of dexamethasone, ondansetron, and metoclopramide in patients undergoing gynecological surgery. Med. Sci. Monit. 2010; 16(7): CR336–341.
Sun R., Klein K.W., White P.F. The effect of timing of ondansetron administration in outpatients undergoing otolaryngologic surgery. Anesth. Analg. 1997; 84(2): 331–336.
Tang J., Wang B., White P.F., Watcha M.F., Qi J., Wender R.H. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth. Analg. 1998; 86(2): 274–282.
Horosz B., Nawrocka K., Malec-Milewska M. Anaesthetic perioperative management according to the ERAS protocol. Anaesthesiol. Intensive Ther. 2016; 48(1): 49–54, doi: 10.5603/AIT.2016.0006.
Rüsch D., Eberhart L.H., Wallenborn J., Kranke P. Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment. Dtsch. Arztebl. Int. 2010; 107(42): 733–741, doi: 10.3238/arztebl.2010.0733.
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